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DOC
LAP
CAP
NHA
NUCC
BAO CAO
TONG
HOP
KET QUA KHOA HQC CONG NGHE DE TAI
NGHIEN
CLTU
DAC DIEM DICH
TE
HOC,
LAM
SANG
BENH
TA
VA
DE
XUAT
CAC GIAI
PHAP
PHONG CHONG DICH
d
VIET NAM
MA SO: DTDL. 2008 G/21
Chii
nhiem de
tai

1.
Fen de tai, du an: "Nghien
ciiu
dac diem dich te hpc, lam sang benh ta va de xuat
cac giai phap phong chong dich tai Viet Nam"
Mas6;
0TDL.2OO8
G/21
Thuoc:
- De tai doc lap cap nha nuoc ITnh vuc Y duoc
2.
Thoi gian thuc hien : 01/2008- 3/2010
3.
T6
chiic
chii
tri: Bp Y te
4.
Co quan chu quan: Vien Ve sinh Djch te Trung ucmg
5.
Tac gia thuc hien de tai tren gom nhiing ngucri co ten trong danh sach sau (khong
qud 10 ngudi):
So
TT
1.
2.
3.
4.
5.
6.

To chirc cong tdc
Vien Ve sinh dich te
TtT
Benh vien Benh truyen
nhi€m
Trung
iroTig
Vien Ve sinh djch te
TIT
Vien Ve sinh djch tl
TIT
Vien Ve sinh djch te Tl/
Vien Ve sinh djch te
TIT
Vien Ve sinh djch te
TlT
Vien Ve sinh djch te
TIT
Vien Ve sinh djch tl
1XS
Vien Ve sinh djch tl
TU"
Chieky
1,1
g
y
44Z7/
VM^
JdL
(1

jVpf.
ngay thdng nam
2010.
DANH SACH CAC TAG GIA THAM GIA
THl/C HI^N
DK TAI KHCN CAP NHA
NlTdC
1.
Ten
d6
tai, du an:
"Nghi6n
ciiu
d^c
diem dich te hpc. lam
s^ng
benh ta
v^
de xuat
cac giai phap phong
ch6ng
djch
t?i
Vi$t Nam"
Masa:
0TDL.2OO8G/21
Thupc:
D^
tai dpc lap cap nha nuac ITnh
virc

Chiic
danh
khoa
hgc,
hgc vi,
hg
va tSn
BS.
Vu Dinh
ThiSm
CN.
Phjm
Thj Cam Ha
BS.
Ngo
Huy
Tii
Ths.
BS. Nguyen C6ng Khanh
BS.
Ngu Duy Nghia
Bs.
Pham
Dire
Tho
Ths.
BS. Pham Quang Thai
BS.
Nguyen
Hihi

Vien Ve sinh djch te Trung
uong
Vien Ve sinh djch te Trung
uong
Vien Vf sinh dich te Trung
uong
Trung tam Y te du phong tinh Thanh Hoa
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.

PGS.
TS.
Ph?m
Van Ca
Ths.
BS. Nguyen Trung Cap
Ths.
Nguyen Tien Lam
PGS.
TS. Nguyen Vii Trung
Ths.
Dao Tuyet Trinh
Ths.
BS.
T?
Thi Dieu Ngan
BS
CKII.
Nguyen Minh Ha
BS
CKI.
Doan Van Trung
Ths.
BS.
Tr4n
Thi
Phu-ong
Thuy
BS.
Tran Thj Hai Ninh

Benh
viin
Benh Nhift Ddi Trung vong
Bfnh vifn Bfnh
Nhift Ddi Trung uong
Bf nh
vifn
Benh Nhift Ddi Trung
uomg
Benh vien Benh Nhiet Ddi Trung uong
Benh vien Bfnh Nhift Ddi Trung uong
Bf nh
vifn Bfnh Nhift
Ddi Trung
inmg
Benh vien Benh
Nhift
Ddi Trung
uong
.^j;:
Bfnh
vifn
Bfnh Nhiet Ddi Trung uong
Benh
vifn
Bfnh Nhift Ddi Trung uong
Bfnh vifn
Benh
Nhift
Ddi Trung

47.
BS.
Va Thuy Hanh
BS.
Nguyin Gia Thirc
BS.
Ha Hiru Tiing
BS.
Nguyen Quang Tuan
BS.
Nguyen Hanh Chung
BS.
Biii Due
Long
BS.
Le Trung Dung
BS.
Nguyen Hoai Nam
BS.
Trkn
Van
Lugng
BS.
LS Qui
BS.
Nguyin
XuSn
Hoa
Benh vien
0a

CAC
Ki
Hl£U,
CHU^
VI£T
TAT
6
DANH
MVC
CAC BANG 12
DANH
MVC
CAC HINH 18
DANH
MVC
CAC
BifeU
D6
22
MdDAU 25
CHirONG
1. TONG QUAN 29
1.1. Tinh hinh nghien curu ngoai
nirac
lien quan den
de
tai 29
1.2.
Tinh hinh nghien
cihi

1.4.4.
Cac
yeu
to nguy
ca cua benh
ta 43
1.5. Mpt so yeu to canh bao dich 44
1.6.
Dac
dilm lam sang cua benh ta 45
1.6.1.
Tri$u
chung cua
b$nh
ta 45
1.6.2.
Chandoan
46
1.6.3.
Dilu
tri 46
1.7.
Xiily
6 dich va
dy
phong benh ta 47
CHU^OfNG
2. VAT
U?U
VA

vi
dia
ly 57
2.1.1.3.
Xdc
dinh
cdc yiu to nguy
ca
52
2.1.1.4. Xdc dinh
tyle
ngudi
lanh mang
vi
khudn
td
a mot so vung co dich
63
2.1.1.5.
Nghien cuu xdc
dinh
su luu
hdnh
cua vi
khudn td/E.coli o moi
trudng
nu&c,
thuc phdm
va
d0ng

2.1.2.
Dac
diem Idm sdng cua
b^nh
td
2.2.
D5c
diem djch tl hpc phan
tii ciia bfnh
td vd dp dyng trong dy bdo djch 90
2.2.1.
DJc
dilm djch te hpc phan
til
2.2.2. Cdc chi so cdnh bdo djch td
'"^
2.3.
Nghign
cihi
hodn thien quy trinh
chin
dodn vd
di^u
trj bfnh td
113
2.4. Nghign
ciiu
hodn
thifn
quy trinh

bdn
id djch ti
benh
ta
lai
Hd
N0i
bing mg
dvng
kp thudt
hfthSng dinh vi dia ly (GPS) HI
3
1.1.3.
Xdc dinh
Ciic
yiu l6
nguy
ca
ciia
b^nh
td
136
3.1.1.4.
Xdc
dinh
ty le ngudi
lanh mang
vi
khudn tadm0l
s6 vitng c6 dich

Xdc
dinh
muc
dq khdng thuoc khdng
sinh cua
cdc
chung vi khudn
td
vd
khd nang sinh
doc
id theo dia duvd
thdi
gian.
178
3.1.2.
Mo td ddc dilm lam sdng bfnh td a miln Bdc Vift Nam 2009 185
3.1.2.1.
Bgcdiemchung cim benh nhdn
vd
mat so yeu
to
nguy ca lien quan
den khd ndng nhiem
td 185
3.1.2.2. Bac diim ldm sdng
cua
cdc
benh nhdn
mdc bfnh Id 190

0139 va NAG trong
moi trudng nuac 212
3.2.2.2.
Kit qud
phdn
lap
vibriophage va
xdc dinh
Ogc
diim hinh dang cia
vibriophage
2I6
3.2.2.3.
Hinh
dgng
vibriophage quan sdt
dudi kinh hiin vi diln
tic 217
3.2.2.4.
Kit qud phat hiinfllamentousvd
kappa phage
220
3.2.2.5. Bi xudt chi s6
dv bdo 222
3.3.
Hoan thien quy trinh chan doan va dieu tri benh ta 223
3.3.1.
Danh gia ve viec bu dich duong uong trong vu dich ta 2007 - 2009 tai
mi§n
Bac Viet Nam 223

249
3.4.1.
Dinh nghTa, phat hien ca
benli
249
3.4.2.
Xir lyo
dich 250
3.4.2
1
Doi vai
benh nhdn
250
3.4.2.2.
Tieu chudn
cho
binh
nhdn
ra viin 251
3.4.2.3.
Xulyphdn
vd
chdt
thdi
cua
binh
nhdn 251
3.4.2.4. Xu ly moi
truong xung quanh
253

4.1.1.
Dac
diem dich
te hoc
cua
benh ta 258
4.1.1.1.
Dgc
di&m
dich ti
hoc
cita dich
td
ndm 2007 - 2009
258
4.1.1.2. Phdn bo
benh nhdn theo
giai 262
4.1.1.3. Phdn bo
benh nhdn theo nhom
tuoi 262
4.1.1.4. Phdn bo
benh nhdn theo nghe nghiep
263
4.1.1.5.
Xdy dung
bdn
do
dich
te

4.1.1.8.
Xdc dinh su luu
hdnh
cua
vi
khudn
td/E.
coli
a
moi
truong nuac,
thucphdm vd ddng vat
thuy sinh
d
cdc
viingco dich 278
4.1.1.9. Xdc dinh muc do
khdng thuoc khdng sinh
cua
cdc
chung
vi
khudn
td
vd
khd
ndng sinh dpc
td
theo
dia

Ddc diem djch tl hpc phan tir vd dp dyng trong dy bdo djch 292
4.2.1.
Ddc di6m
djch tl hpc phan
til ^'^
4.2.2.
Cdc chi s6 canh bdo djch
2'*
4.2.3.
Hodn thifn quy trinh chan dodn vd
di^u
trj bfnh td 302
4.2.3.1.
Lieu
phdp
bil
dich duang
uong ^"^
4.2.3.2.
Lieu
phdp iruyin
dich • •'''•'
4.2.3.3. vi so
luQmg dich
Iruyin
trong 5
ngdy
ddu.
•'"(J
4.2.3.4. Anh

cdc thudc
chdng tiSu
chdy 312
4.2.3.8. Bdnh gid cdc
bien
phdp
hoi siic bfnh
nhdn ndng 313
4.3.
Hodn thifn quy trinh
xii
ly vd dy ph6ng bfnh td 314
CHU'ONG 5.
K^TLUAN
316
5.1.
DJc di^m
djch ti hpc vd lam sdng bfnh td
316
5.1.1.
Dich tl hpc bfnh td ndm 2007 - 2009
tjii
mien Bdc 316
5.1.1.1.
Ddc diem dich te hoc
ciia
vu dich 316
5.1.1.2.
Cdcyeu
to nguy co

sinh
d0c tS
cua
cdc
chiing vi khudn Id
theo dia
duvd thai
gian 317
5.1.2. Dac diem lam sang benh td 318
5.2. Ddc dilm dich tl hgc phdn
tii
vd dp dyng trong dy bdo djch
318
5.2.1.
Ddc
di^m
chiing vi
khuk
td Vift Nam gdy djch 318
5.2.2. Cac chi so
cdnh bdo
djch
td
318
5.3.
Hoan thifn quy trinh chan dodn va dilu
trj
bfnh td
318
5.3.1.

huylt thanh khdng td
djc hifu
vd bp sinh
pham
chin
dodn nhganh vi khudn td 319
5.6. Sdn xudt 3000 mdu huyet thanh khdng ta moi loai: (da gid nhom Ol, da gid
nhom
0139,
don gid Ogawa, don gid
Inaba)
dat tieu chudn co sd
319
5.7. San xudt
dupe
100 bp sinh phdm chan dodn nhanh vi khudn ta mdi bp
1
test
djt ti6u
chudn co sd
319
CHU'ONG 6. KIEN NGHJ
320
TAI LIEU THAM KHAO
321
PHV LVC
330
Phu lyc
1:
QUY TRINH CHAN DOAN SCiM BENH TA

BENH
CHLTNG
373
Phu lyc 8: SO
D6
CAC
BU6C
DIEU TRA NGHIEN CUU XAC DINH
YEU TO NGUY CO VA NGUON GOC VU DICH
380
Phu lyc 9: BIEN
BAN
HQP
vA
KET
LUAN
CUA HOI
D6NG
Y
DlTC 381
Phu luc 10:
GIAY
CHLTNG
NHAN
KIEM DICH DONG
VAT
NHAP KHAU
382
Phu
lyc 11:

15:
KET QUA KHANG SINH DO CUA CAC
CHtJNG
V.cholerae 01
BANG KY THUAT MIC
389
DANH
MVC CAC KY
HI$U,
CHU"
VIET
TAT
ADN Acid desoxyribonucleotid
(Deoxyribonucleic acid)
AIDS
H6i
chiing suy giam mien djch
mSc ph^i
ATCC American Type Culture Collection
BGLB
Canh thang BGLB
(Brilliant Green Lactose Bile)
BUI Canh thang nao tim
(Brain Heart Infusion)
BN Benh nhan
BS Bac sy
Candida Nam Candida
CBTNNDQG
Cac benh truyen nhiem va nhiet dai
qu6c

DMSO Dimethyl sulfoxide
E.coli
Escherichia
coll
ELISA
Thii
nghiem mien dich gan men
(Enzyme-linked Immunosorbent Assay)
ER Moi truong ER
FAO To chiic nong luong quoc te
(Food and Agriculture Organization)
FDA Co quan Quan ly thuoc va thuc pham, My
(Food Drug
Adminitration)
GAP Thuc hanh nong nghiep tot
(Good Agricultural Practice)
GIS He thong thong tin dia ly
(Geographic Information System)
GPS He thong dinh vj toan cau
(Global Position System)
HA Huyet ap
HAT Hypoxanthine Aminopterin Thymidine
HAtt Huyet ap toi thieu
HBV Vi nit viem gan B
(Hepatitis B virus)
HEPES Hydroxy Ethyl
Pipeiazineethane
Sulfonic acid
mv
HT

(Luria Bertani)
Lysin decaborxylaza
Lipopolysaccharide
Lauryl tryptose broth
Khang the don dong
(Monoclonal Antibody)
N6ng
dp
lie
che
t6i
thieu
(Minimum Inhibitory Concentration)
So
CO
the nhat
(Most Possible Number)
Vibrio khong ngung ket
(Non Agglutination vibrios)
Uy ban Quoc gia
v6
Cac tieu
chuSn
can lam sa
(National Committee for Clinical Laboratory
Standards)
Mat do quang
hpc/Do due
OR
ORS

toan/Khang
trung gian/Nhay cam
(Resistance/Intermediate/Sensitive)
Khuyech dai ngau nhien cac doan DNA da hinh
(Randomly Amplified Polymorphic DNA)
Ky thuat ngung ket latex thu dong dao ngupc
(Revered Passive Latex Agglutination)
Staphylococcus
aureus
Moi truong SR
Dung dich dem TAE
(Tris
Aeetat
EDTA)
Dung dich dem TBE
(Tris Borat EDTA)
Muoi mat Thiosulfate Citrat
(Thiosulfate Citrat Bile
Salt)
Yeu to xam nhap
TCVN
TCYTTG
TE
TSKL
TSVK
TTYT
TTYTDP
TW
V.cholerae
v.p.

World Health Organisation
(T6 chijrc
Y tl
Thi
giai)
Y tl du phong
10
KY
HIEU
CUA MQT SO
LOAI KHANG SINH
(theo WHO-NET)
AMP
AUG
CHL
CFX
CL
GEN
LVX
NOR
STR
TCY
Ampicillin
Augmentin
Chloramphenicol
Ceftriaxone
Clindamycin
Gentamicin
Levofloxacin
Norfloxacin

,.
'
73
ta
Bdng
2-2.
Cdc cap mdi dung
trong
phdn
img
PCR xdc dinh muc dp
khdng
khdng
sinh ciia
cdc chung vi khuan td
°'
Bdng
2-3.
Dgc
diim
phdn
bi?t
typ sinh hpc co dien vd El Tor 95
Bdng
2-4.
Mqt
sd cap mdi
sic
dung trong ky thuat PCR xdc dinh dac tinh
CTX

3-1.
Phdn bd theo dia du
cdc trucmg
hap mdc td mien Bdc,
Viet
Nam,
2007-2009 125
Bdng
3-2.
Thai gian keo ddi cdc dat dich trong vu dich ndm 2007 - 2009
130
Bdng
3-3.
Kit qud cdc chiim ca benh td ldm sang
tgi
Hd Noi xdc dinh bang
phdn mem
STatScan
135
Bdng
3-4.
Ket qud dieu tra dich te 4 ca
binh ddu
tien trong cdc
d0
dich tit
2007-2009
137
Bdng
3-5.

cdc
dot dich td tic ndm 2007-2009
141
Bdng
3-9.
Ket qud xet
nghiem
mdu
nude
dinh ky
tie
thdng
4/2008
den thdng
3/2009
142
Bdng
3-10.
Kit qud xet nghiem mdu rau tham, rau sdng tgi cdc cira hdng
lien quan din
benh
nhdn td trong 3 dat
dich 2007
-
2008.
143
Bdng
3-11.
Kit qud xet
nghiem

3-15.
Kit qud xet nghiem mdu mdm tdm tgi cdc cita
hdng,
chg
ddu
mdi,
casd sdn
xudt 148
Bdng
3-16.
Kit qud xet
nghiem
cdc mdu binh phdm tgi mot sd
cira
hdng thit
cho
trong
vu dich
ndm
2007 - 2009
149
Bdng
3-17.
Hinh
thiec
cung cdp thit chd cho cdc cua hdng 150
Bdng
3-18.
Tinh
trgng chd khi mang din cdc cua hdng 150

Kit qud xet nghiim cdc mdu binh phdm khac tgi xa Thdnh
U"^
156
Bdng
3-24.
Dgc diim vi ddi tugng vd
dia
diim nghiin cuu binh
chiing
162
Bdng
3-25.
Cdc dgc diim nhdn khdu hgc
ciig
nhdm binh vg nhdm chung. 163
Bdng
3-26.
Mgt sd yiu td nguy ca liin qugn vdi dich tg trong phdn tich da
biin
'64
Bdng
3-27.
Biiu hiin ldm sdng
cita
cdc nhdm chd thitc nghiim 165
Bdng
3-28.
Thai gian ddo thdi vi khudn tg ra phdn cua chd sau khi
gdy
nhiim

Ol bdng ky
thudt
MC 181
Bdng
3-35.
Kit qud khdng sinh do vd gen khdng khdng sinh cua cdc chung vi
khudn td 182
Bdng
3-36.
Kit qud dinh lugng dgc td td cua cdc chung
V.cholerae
Ol
184
Bdng
3-37.
Phdn bd tudi cua cdc binh nhdn mdc td miin Bdc, Viit Nam,
2009 185
Bdng
3-38.
Phdn bd vi nghi nghiip 186
Bdng
3-39.
Phdn bd vi dia du
hdnh
chinh 187
Bdng
3-40.
Ty
U
binh nhdn cd binh mgn tinhphdi hgp 188

Thay
do
creatinin
mdu
a
binh nhdn td 195
Bdng
3-47.
Thay
ddi vi khi
mdu
a binh nhdn td
196
Bdng
3-48.
Thay
ddi Kali
mdu
d binh nhdn td 196
Bdng
3-49.
Ket qud dinh typ
sinh
hgc 198
Bdng
3-50.
Trinh
tu
cdc
a xit

3-54.
Kit
qud
phdt
hiinfsl,fs2 tgi
Hdi Phdng vd
Thdi Binh
221
Bdng
3-55.
Kit qud phdt hiin kappa phage
tgi
Hdi Phdng vd
Thdi
Binh
222
Bdng
3-56.
Ty le benh nhdn duac
bii dich
trudc khi din viin 223
Bdng
3-57.
Ty
li binh nhdn
sie dung cdc biin
phdp
bil
dich tgi nhd 224
Bdng

dich truyen vd
ORS
udng 227
Bdng
3-63.
Sd lugng
dich
truyin dich trong
gid
ddu
2^'
Bdng
3-64.
Sd lugng
dich
truyin trong ngdy ddu
2^°
Bdng
3-65.
Sd lugng cdc logi
dich
truyin trong cdc ngdy 228
Bdng
3-66.
Anh
hudmg
cua truyin dich din Natri mdu 229
Bdng
3-67.
Anh hudng

3-72.
Kiiu di khdng cua
V.cholerae
Ogawa ndm 2008. 234
Bdng
3-73.
So sdnh su
khde
biit vi ty li nhgy cdm vdi khdng sinh
cOa
cdc
chiing V. cholerae Ol Ogawa bdng 2 phuang phdp 235
Bdng
3-74.
So sdnh su khde biit vi ty li trung gian cua cdc chiing
V.cholerae
Ol Ogawa bdng
2
phuang phdp 236
Bdng
3-75.
So sdnh su
khde
biit vi ty li khdng
ciig
cdc chiing
V.cholerae
Ol
Ogawa bdng
2

Ty li binh nhdn td cd biin chiing 240
Bdng
3-83.
Anh hu&ng
cOa
gidi din thai gian ndn viin, thdi gian cdn tieu
chdy,
thdi
gian cdn
vi
khudn td trongphdn 241
Bdng
3-84.
Anh hudng cug gidi din ty li biin chimg 242
Bdng
3-85.
Anh huang cua binh nin din
thdi gian
cdn tieu chdy 242
Bdng
3-86.
Ty li binh nhdn diing thudc chdng tieu chdy trudc khi den viin
243
Bdng
3-87.
Anh hudng
ciia
thudc chdng tieu chdy den tinh trgng mdt
nude
244

thdn
247
Bdng3-94. Cdc biin phdp
xie
tri
suy thdn
248
Bdng
3-95.
Xu tri
toan
hda mdu
sau
khi binh nhdn da
thoat sdc
249
Bdng
3-96.
Xu tri
hg
kali
mdu
249
DANH
MVC
CAC
H!NH
Hmh
1-1.
Phdn bd dich td trin

Khudn lgc E.coli tren mdi trudng Endo
71
Hmh
2-4.
Tinh chdt sinh hda
ciia
E.coli 72
Hmh
2-5.
Sa dd quy trinh cdy thic nghiim
sye
thich ung cua vi khudn td
trong
mdm
tdm 79
Hinh
2-6.
Kit qud
ducmg
tinh cdc miic dg 86
Hinh
2-7.
Chudn
bi mdu
ggc tdm
104
Hinh
2-8.
Hinh dnh dgt vd thu thgp mdu ggc tdm
108

Hinh
3-5.
Bdn
do
phdn bd
mice
do tgp trung cdc ca binh td tgi Hd Ngi theo
kit qud GPS trong thdi gian ddu cua
v^
dich
10/2007
- 04/2008
133
18
Hinh
3-6.
Bdn do phdn bd cdc chiim ca binh td ldm sdng tgi Hd Ndi sti
dung phdn tich khdng gian thdi gian ddu cua vu dich
10/2007
-
04/2008 134
Hinh
3-7.
Bdn dd phdn bd cdc ca binh td tgi Hd Ngi theo quy md
xd/phudng dgt
dich
td 1 vd 2 135
Hmh
3-8.
Bdn do phdn bd cdc ca binh td tgi Hd Ngi theo quy md

Nam
qua ciia khdu
Cdu
Treo,
Hd Tinh 159
Hinh
3-12.
Xe chd chd ciia cdng ty nhgp khdu tgi Trgm kiim dich ddng vdt
Cdu
Treo,
Hd Tinh 160
Hinh
3-13.
Thuyin chuyin chd nhgp
khdu
vdo ndi dia
Viet Nam
161
Hinh
3-14.
Chuyin chd tiexe
cita
Lao
sangxe
ciia
Viet Nam
161
Hinh
3-15.
Chd mdc td diin

ctxA bdng
1^
thudt PCR
184
Hinh
3-20.
Hinh dnh ky thudt RPLA xdc dinh ndng dd ddc td td cda
V.cholerae
Ol 184